Bilateral facial palsy (BFP) is exceedingly rare, representing only 0.3%-2.0% of facial palsy cases. Unlike unilateral facial palsy, it is often caused by a serious underlying systemic disease and therefore warrants urgent medical intervention. The differential diagnosis is broad, and detailed history, physical examination, and investigations are essential for identifying the etiology. Common acquired causes in existing case series include Lyme disease, Guillain-Barré syndrome, sarcoidosis, trauma, and Bell's palsy. Palsy that develops rapidly is often caused by trauma, infections, or autoimmune disorders, whereas slow progressive palsy suggests neoplastic diseases. While management varies by etiology, the physician can consider early empiric corticosteroids given their efficacy in numerous differential diagnoses. Antivirals can be considered in those with a strong history of viral prodrome. In this paper, we present the case of a puerperal patient with BFP and discuss its differential diagnosis, diagnostic approach, and management.In Pakistan, due to legal and religious association, cases of attempted suicides are underreported in Pakistan, yet it is essential to have accurate data so that the causality leading to this national tragedy can be studied and minimized. Psychiatric disorders leading to suicide is largely neglected and under-researched in Pakistan. In this study, we aim to observe the frequency of psychiatric disorders among suicide attempters, which can help the doctors to counsel and treat the patients better and devise preventive strategies.
In this cross-sectional survey, patients brought to emergency with attempted suicide were enrolled in the study, after taking informed consent from the attendant. After initial treatment, the patient's clinical history was sought via a General Health Questionnaire-28. Once recognized, participants underwent detailed psychiatric evaluation and mental state examination.
Three hundred and fifty-two (352) patients were brought to the emergency with attempted suicide, of which249 (70ric disorders. Patients inflicting self-harm or failing at suicidal attempt are inclined towards attempting suicide in future. However, the social stigma associated with psychiatric disorders has heavily affected the process of successfully identifying and treating such patients. Along with focused long-term treatment, follow-up, and enhanced surveillance programs, mass awareness campaigns should be conducted to improve the knowledge and outlook of the general population towards psychiatric disorders.Dementia with Lewy bodies (DLB) is recognized as the second most common form of dementia in aged people. It is well known that patients with DLB often develop various autonomic symptoms. Here, we present a case in which there was sick sinus syndrome mimicking the DLB-related autonomic dysfunctions. After the pacemaker implantation, the patient's symptom perfectly extinguished. It is essential for psychiatrists or other professionals who are mainly seeing dementia patients to rule out critical causes that may mimic autonomic symptoms in patients with DLB.Homocystinuria is a metabolic disorder caused by a deficiency of cystathionine beta-synthase with autosomal recessive inheritance. Clinically it is characterized by lens subluxation, skeletal abnormalities, and thromboembolic accidents. We present a 6-year-old boy who was a known case of homocystinuria. The patient had a previous history of thrombotic cerebrovascular infarction at the age of 3. He had mild and vague pain in the left eye two weeks before presentation without being exposed to trauma. Ophthalmic examination revealed the dislocation of the crystalline lens into the anterior chamber with diffuse corneal stromal edema in the affected eye. The patient was treated with topical atropine and betamethasone eye drops, but due to the corneo-lenticular contact and corneal edema, he underwent lens extraction and placement of iris-fixated intraocular lens after 48 hours. Corneal edema exhibited improvement at follow-up visits. Early age onset and unilateral complete lens dislocation to the anterior chamber in the absence of a history of trauma is a less common presentation of homocystinuria. In patients with systemic diseases including homocystinuria that cause zonulysis, lens dislocation is usually symmetric and bilateral. Nevertheless, in unilateral cases especially in those who did not have any history of trauma, evaluation for systemic diseases like homocystinuria is necessary for early diagnosis and prevention from other systemic involvements.Siliconomas are rare conditions stemming from uses of silicone injections for soft tissue augmentation, most commonly in the breast and buttocks areas. Siliconomas are known to present with suspicious morphology that mimics cases of embolism or systemic metastasis as the silicone travels through blood and lymphatics. We present the case of a 45-year-old HIV-positive male who presented with siliconomas in the breast region, chest heaviness, shortness of breath, dyspnea, and a physical exam showing gynecomastia. The patient denied any surgeries or injections around his chest. https://www.selleckchem.com/products/ink128.html Further imaging showed abnormal fat deposition in the chest and possible metastatic lymphadenopathy to axillary, supraclavicular, and mammillary lymph nodes. Although the complications arising from silicone injections are well documented, the pathogenesis remains unknown, leaving a narrow range of therapeutic options. Despite these shortcomings, diagnostic imaging tools have shown to be vital in the diagnosis and localization of suspected siliconomas.Urinary diversion, a surgical technique to redirect urine usually after cystectomy, and its complications are potential challenges to physicians and early recognition decreases mortality and morbidity. A 45-year-old male with a history of type 2 diabetes mellitus and hypertension for over three years underwent urinary diversion as a treatment for invasive bladder cancer and was discharged ambulatory with an indwelling Foleys catheter. The patient returned to the emergency room with a primary complaint of hematuria. The patient was noted to be frail-looking, dehydrated and tachycardic. Laboratory results yielded an acute kidney injury reflected by the elevated creatinine, hyperkalemia and a venous blood gas demonstrating a hyperchloremic metabolic acidosis. The patient had bilateral distended renal calyces by ultrasound and irrigation of bladder through a three-way Foley showed to have large thick clots. The patient was admitted under the surgical intensive care unit after involving appropriate sub-specialties.